Lupus Skin Rash

Most people with lupus have skin symptoms at some point in their lives. About 2 out of 3 people with lupus develop cutaneous lupus erythematosus (CLE). People with CLE develop skin rashes or sores. Different types of CLE can cause specific skin rashes. Other skin issues not specific to lupus can also happen.¹

Skin symptoms include rashes, sores, and lesions. They can occur from your head to your toes. Other conditions like rosacea and sunburn may look similar. Talk to your doctor about your symptoms and possible treatments.²

Lupus is more common in people of color. Skin rashes may look different for people with darker skin tones. But most information and research is based on people with lighter skin tones. This can cause doctors to misdiagnose lupus skin rashes in people of color.³

What do lupus skin rashes look like?

People with lupus can get different kinds of rashes. Some people get multiple types of rashes.^1,2,4

Discoid lupus rash

A discoid lupus rash is caused by a form of CLE called discoid lupus erythematosus (DLE). DLE is the most common type of CLE. A discoid rash often appears on the face, ears, and scalp. But it can appear anywhere on the body. This type of rash often:^1,4,5

• Has circular or disk-shaped red or purple patches that are thick and scaly
• Does not itch or cause pain
• Causes scarring and skin color changes

Chronic (ongoing) discoid rashes or sores can increase your risk of skin cancer. People with DLE may need more frequent screenings for skin cancer.¹

Subacute CLE rash

Subacute CLE rashes often appear on body parts exposed to the sun. These rashes tend to be circular and red or purple. They:^1,4,5

• Connect to form interlocking circles
• Do not itch or cause pain
• Will not cause scarring but may lighten or darken skin

Malar ("butterfly") rash

A malar rash is caused by acute CLE. Acute CLE may also cause other types of rashes. A malar rash is raised, red or purple, and shaped like a butterfly. It spreads across the cheeks and nose. Malar rashes tend to happen when you have a lupus flare-up. They occur in about half of people with lupus.^1,4,5

Other common skin problems with lupus

People with lupus can develop many other skin rashes, sores, and lesions. Some of these skin problems include:^2,4

• Alopecia – 7 in 10 people with lupus experience hair loss, often from scarring left by discoid rashes
• Oral and nasal ulcers – 1 in 4 people with lupus have lesions or sores in the mouth, nose, or eyes
• Raynaud’s phenomenon – 1 in 3 people with lupus have skin color changes or ulcers on their fingers or toes, triggered by cold temperatures
• Hives – 1 in 10 people with lupus have itchy and raised rashes that last more than 24 hours
• Purpura – 1 in 7 people with lupus have small red or purple discolorations under the skin

Why does lupus cause skin rashes?

All types of lupus are autoimmune conditions. This means your immune system is overactive and attacks healthy cells. When your immune system attacks healthy skin cells, it increases skin inflammation. This can cause symptoms, including different types of lupus rashes.¹

Lupus rashes are often triggered by exposure to sunlight. This is called photosensitivity. Up to 70 percent of people with lupus experience photosensitivity. Immune cells in your skin react to ultraviolet light and release chemicals. This causes rashes that look like sunburn. Sun exposure can trigger other lupus symptoms, such as joint pain and fatigue.^1,4

How are lupus skin rashes prevented and treated?

Regularly taking the medicines you are prescribed and avoiding sun exposure can control inflammation and skin rashes. It can relieve symptoms, prevent scarring, and stop permanent hair loss.^2,6

Many treatments can reduce skin inflammation and itchiness. The best option for you depends on your specific symptoms. A doctor who specializes in skin conditions (a dermatologist) may suggest possible treatments. Treatments and management techniques include:^1,2,6,7

• Avoiding sunlight and fluorescent lights
• Using sunscreen of at least SPF 30, even when indoors
• Wearing a wide-brimmed hat and tightly woven clothes when outdoors
• Topical steroid ointments, creams, or gels
• Steroid pills or injections
• Antimalarial drugs, such as hydroxychloroquine (Plaquenil®)
• Immunosuppressant creams, such as tacrolimus (Protopic®) and pills, such as thalidomide (Thalomid®)
• Systemic immunosuppressants such as methotrexate (Rheumatrex®), cyclosporine (Neoral®, Sandimmune®, Gengraf®), and mycophenolate mofetil (Cellcept®)
• Laser therapy
• Biologics, such as rituximab (Rituxan®), which targets a specific immune cell called B cell to reduce inflammation

Talk to your doctor about the side effects of lupus skin treatments.